Thinking of giving up school nursing position for Home Health... need advice

Brooke Schmidt, BSN, RN · May 2, 2013

I work for a home health agency, we do shift work which sounds like what you're interested in. I work full time with one patient (3, 12 hour shifts). Many nurses work with more than one patient or agency depending on the hours and experience you want. I only drive to and from my patients home. These cases are usually medically complex children or adults with trachs/vents/central lines/g-j tubes and they will qualify for a certain number of hours per day/night.

RoseBSNRN · May 2, 2013

Here is my opinion: neither being a school nurse or a home health nurse is going to help or deter you from getting a hospital nurse job in the future. So essentially, either of the job options you currently have is going to negatively effect your prospects of working in a hospital. Hospitals look for nurses who have hospital nursing experience as a matter of priority. Having said that, you must concentrate (or if I were you, I would) on getting a BSN degree because lot of the hospitals are getting away from hiring lower credentialed nurses like LVN/LPN and only hiring RNs and then within the RN credentialed nurses there are many hospitals which are requiring RNs have a BSN or you are out of a job in a hospital after they have give you a chance and time to obtain your bachelors degree.

It appears that you love kids A LOT and if that is your motivating influence to be a satisfying nurse then stick with school nursing. You might also love elderly people that you will encounter for the most part in home health. You will never know till you try. Home health is a very rewarding experience both qualitatively speaking and also quantitatively ($$). With nursing, the good thing is the door is wide open for you to find your own niche, satisfaction, as well as your mark on the profession. Rose APRN/NP

AnnemRN · May 2, 2013

I have been working for a year at a school for children with special needs. Although I LOVE working with the kids, I feel like I need a change for many reasons. I work in a health center with other nurses, and while I have learned a lot of skills, I feel that I've hit a plateau. I'm very micromanaged and the pay is horrible... but I love the kids.
Since I don't really have hospital experience or a BSN, hospitals won't look at me.
I'm considering a home health position. It pays almost $20,000 more a year than what I'm making. I think I would enjoy the autonomy but kind of nervous that it would be dangerous going into people's homes. In the interview, she could not tell me exactly what neighborhoods I would be covering only the general area of the city, but when asked about safety issues, she just said there are some low income neighborhoods but if I ever felt unsafe, I could call for another nurse to go with me.
I plan on starting a BSN program very soon. I'm wondering also which experience would look better on a resume if I ever do want to transfer to a hospital... the school vs. home health. Any thoughts? Does anyone working in home health feel like it's dangerous?

I've been in home health for 19 yrs. It's pretty busy even when using a laptop or tablet. The one thing I really didn't like when I worked as a full time case manager was being required to take overnight call (5p to 8a). You work all day and then take call at night the frequency will vary depending on your agency. You're troubleshooting problems so, sometimes you can do it over the phone but, there were many times when I had to go out in bad weather or into bad neighborhoods late at night.

Be sure to ask if you will be required to take call as it might be a deal breaker. I now work part time and never do call.

isednom · May 2, 2013

I have been a home health case manager for 12 years. I only know about HH nursing. I would confirm that the job does have a lot of paperwork. The easiest "start of care" patient takes 2 hours using our computer system, with all necessary communication included and all paperwork, once you have it down cold. The most challenging thing about the job is the communication piece. If you do home health right, you will be finding ways to contact your PTs, OTs, home health aides, social workers, along with doctors, and your own boss/supervisor, who will be wanting to know if that new patient needs some therapy, especially if he has Medicare insurance (kidding, sort of)!

The job will grow your skills greatly is the best thing I can say. You will become more independent as a clinician, and will likely grown critical thinking skills as you are "out there on your own" a lot. You will also get to talk a lot to old people, which should certainly be considered. In response to other nurses above, you also have to tell your supervisors how much work you can do, and don't allow them to pressure you to do more than you can handle. You will get into trouble accepting last referral, as you'll be tired and stressed, particularly as you learn the job. Finally, a home nurse really needs to learn how to cut those long conversations off, as you will likely not be paid by the hour, so you will start losing money and time quickly if you don't learn how to give good customer service along with good nursing care.

Long story short: home health is a challenging job, but this is a blessing in the respect that not many nurses want to do it, so you do get a lot of sympathy (in most situations) while you're learning. You do *have* to stand up for yourself. Believe me, these companies need the nursing help so they're not going to fire you unless you're unbelievably incompetent (I've seen many, many home health nurses of all skill levels).

As for safety, I would reiterate what the others have said: the job is during the day (thugs mostly come out at night), nurse safety is most important.

Ooh! One more piece of advice. HH nurses ARE NOT there to do personal care, clean up houses, or bring lunch (never mind paying for their lunch). If you have a patient who cannot take care of these things, GET A SOCIAL WORKER involved. Remember that little pearl. We do not see patients who are not in a safe living environment. A key thing--some of these people need to be in a SNF, assisted living, or, egads, still hospitalized!

I do love home health nursing.